Offline Signup Form

This form should be used to mail Check, Money, Purchase Orders. Please complete the form below. The cost of 1 year (12-month) membership is $29.99 (U.S. Dollars). Please print this page, complete the form below, enclose proper payment and mail the order form to:

Platinum Membership
Teachnology, Inc.
PO Box 631
Fishkill, NY 12524

Account Information: Billing Information:

Name: ___________________________________

My email address is:


Choose a password:_____________________________

Daytime Phone Number: ________________________

After the form is mailed to our offices, you will receive an email confirmation when your account was successfully setup.

Company/School: ___________________________

Address: _________________________________

City: ____________________________________

State: ___________________________________

ZIP Code: ________________________________

Country: _________________________________

Payment Option 1 - Check, Money Order, Purchase Order

________ Check - Check Number ____________________

_______ Money Order - Money Order Number____________________

_______ Purchase Order - Purchase Order Number ________________________

Payment Option 2 - Credit Card Payment Information:

Name on Credit Card: ________________________________

Credit Card Number: _____________________________

Credit Card Expiration Date: _________________________

Credit Card Type: Circle One

American Express, Discover,

Mastercard, Visa